Cognitive Therapy and Research

, Volume 43, Issue 5, pp 893–909 | Cite as

Concurrent and Prospective Relations Between Attentional Biases for Emotional Images and Relapse to Depression

  • Kristin Newman
  • Leanne Quigley
  • Amanda Fernandez
  • Keith Dobson
  • Christopher SearsEmail author
Original Article


This study examined concurrent and prospective associations between attentional biases for emotional images and relapse to depression. Previously depressed (n = 121) and never depressed (n = 28) women completed an eye-tracking task to measure attentional biases for emotional images (face images and naturalistic images) and were then followed for 6 months to assess for relapse to depression. Participants returned for a follow-up session that included the eye-tracking task after a relapse or after 6 months. Previously depressed women who experienced a relapse to depression during the study period showed the hypothesized pattern of decreased attention to positive images and increased attention to negative images, relative to previously depressed women who did not experience a relapse and never depressed women. This was true at the initial visit for naturalistic images and at the follow-up visit for both face and naturalistic images. Women who relapsed had greater attentional biases for some image types at the follow-up visit (when in a state of relapse) than the initial visit (when in a state of remission). Contrary to hypothesis, non-relapsed previously depressed women did not exhibit attentional biases for emotional images relative to never depressed women. Reduced attention to positive images prospectively predicted relapse to depression among the previously depressed women. The results clarify how attentional biases manifest and change from a remitted to relapsed state and provide preliminary evidence for reduced attention to positive information as a risk factor for depression recurrence.


Depression Relapse Recurrence Attentional biases Eye-tracking 



We thank two anonymous reviewers for their excellent feedback and suggestions. This research was supported by the Canadian Institutes of Health Research (CIHR) and the Natural Sciences and Engineering Council of Canada (NSERC).

Compliance with Ethical Standards

Conflict of Interest

Kristin Newman, Leanne Quigley, Amanda Fernandez, Keith Dobson, and Christopher Sears declare that they have no conflict of interest.

Ethical Approval

This research was approved by the authors’ institutional research ethics board (the Conjoint Faculties Research Ethics Board at the University of Calgary).

Informed Consent

Informed consent was obtained from all the individuals participating in the study.

Animal Rights

No animal studies were carried out by the authors for this article.


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn., text rev.) Washington, DC: Author.Google Scholar
  2. Armstrong, T., & Olatunji, B. (2012). Eye tracking of attention in the affective disorders: A meta-analytic review. Clinical Psychology Review, 32, 704–723. Scholar
  3. Arndt, J. E., Newman, K. R., & Sears, C. R. (2014). An eye tracking study of the time course of attention to positive and negative images in dysphoric and non-dysphoric individuals. Journal of Experimental Psychopathology, 5, 399–413. Scholar
  4. Babyak, M. (2004). What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models. Psychosomatic Medicine, 66, 411–421.PubMedGoogle Scholar
  5. Backs-Dermott, B. J., Dobson, K. S., & Jones, S. L. (2010). An evaluation of an integrated model of relapse in depression. Journal of Affective Disorders, 124, 60–67. Scholar
  6. Beck, A., Steer, R., & Brown, G. (1996). Manual for the Beck Depression Inventory-II. San Antonio: Psychological Corporation.Google Scholar
  7. Beevers, C., & Carver, C. (2003). Attentional bias and mood persistence as prospective predictors of dysphoria. Cognitive Therapy and Research, 27, 619–637. Scholar
  8. Burcusa, S., & Iacono, W. (2007). Risk for recurrence in depression. Clinical Psychology Review, 27, 959–985. Scholar
  9. Cannon, D., Tiffany, S., Coon, H., Scholand, M., McMahon, W., & Leppert, M. (2007). The PHQ-9 as a brief assessment of lifetime major depression. Psychological Assessment, 19, 247–251. Scholar
  10. DeRaedt, R., & Koster, E. (2010). Understanding vulnerability for depression from a cognitive neuroscience perspective: A reappraisal of attentional factors and a new conceptual framework. Cognitive, Affective, and Behavioral Neurosciences, 10, 50–70. Scholar
  11. Donges, U., Kersting, A., & Suslow, T. (2012). Women’s greater ability to perceive happy facial emotion automatically: Gender differences in affective priming. PLoS ONE, 7, e41745. Scholar
  12. Elgersma, H. J., Koster, E. H., Vugteveen, J., Hoekzema, A., Penninx, B. W., Bockting, C. L., & de Jong, P. J. (2019). Predictive value of attentional bias for the recurrence of depression: A 4-year prospective study in remitted depressed individuals. Behaviour Research and Therapy, 114, 25–34. Scholar
  13. Elgersma, H. J., Koster, E. H. W., van Tuijl, L. A., Hoekzema, A., Penninx, B. W. J. H., Bockting, C. L. H., et al. (2018). Attentional bias for negative, positive, and threat words in current and remitted depression. PLoS ONE, 13(10), e0205154. Scholar
  14. First, M., Spitzer, R., Gibbon, M., & Williams, J. (1995). Structured clinical interview for DSM-IV axis I disorders. New York: Biometrics Research Department.Google Scholar
  15. Gotlib, I., & Joormann, J. (2010). Cognition and depression: Current status and future directions. Annual Review of Clinical Psychology, 6, 285–312. Scholar
  16. Hook, J., Hodges, E., Whitney, K., & Segal, D. (2007). Structured and semi-structured interviews. In M. Hersen & J. Thomas (Eds.), Handbook of clinical interviewing with adults (pp. 24–37). Los Angeles: Sage.CrossRefGoogle Scholar
  17. Isaac, L., Vrijsen, J., Rinck, M., Speckens, A., & Becker, E. (2014). Shorter gaze duration for happy faces in current but not remitted depression: Evidence from eye movements. Psychiatry Research, 218, 79–86. Scholar
  18. Joormann, J., & Gotlib, I. (2007). Selective attention to emotional faces following recovery from depression. Journal of Abnormal Psychology, 116, 80–85. Scholar
  19. Kellough, J. L., Beevers, C. G., Ellis, A. J., & Wells, T. T. (2008). Time course of selective attention in clinically depressed young adults: An eye-tracking study. Behaviour Research and Therapy, 46, 1238–1243. Scholar
  20. Kemp, A., Silberstein, R., Armstrong, S., & Nathan, P. (2004). Gender differences in the cortical electrophysiological processing of visual emotional stimuli. Neuroimage, 21, 632–646. Scholar
  21. Kessler, R., McGonagle, K., Swartz, M., Blazer, D., & Nelson, C. (1993). Sex and depression in the National comorbidity survey I: Lifetime prevalence, chronicity, and recurrence. Journal of Affective Disorders, 29, 85–96. Scholar
  22. Lazarov, A., Ben-Zion, Z., Shamai, D., Pine, D. S., & Bar-Haim, Y. (2018). Free viewing of sad and happy faces in depression: A potential target for attention bias modification. Journal of Affective Disorders, 238, 94–100. Scholar
  23. Lee, E., Kang, J., Park, I., Kim, J., & An, S. (2008). Is a neutral face really evaluated as being emotionally neutral? Psychiatry Research, 157, 77–85. Scholar
  24. Leppänen, J., Milders, M., Bell, J., Terriere, E., & Hietanen, J. (2004). Depression biases the recognition of emotionally neutral faces. Psychiatry Research, 128, 123–133. Scholar
  25. Lewinsohn, P. M., Steinmetz, J. L., Larson, D. W., & Franklin, J. (1981). Depression-related cognitions: Antecedent or consequence? Journal of Abnormal Psychology, 90, 213–219. Scholar
  26. Lobbestael, J., Leurgans, M., & Arntz, A. (2011). Inter-rater reliability of the structured clinical interview for DSM-IV axis I disorders (SCID I) and axis II disorders (SCID II). Clinical Psychology and Psychotherapy, 18, 75–79. Scholar
  27. Montagne, B., Kessell, R., Frigerio, E., deHaan, E., & Perrett, D. (2005). Sex differences in the perception of affective facial expressions: Do men really lack emotional sensitivity? Cognitive Processing, 6, 136–141. Scholar
  28. Newman, K. R., & Sears, C. R. (2015). Eye gaze tracking reveals different effects of a sad mood induction on the attention of previously depressed and never depressed women. Cognitive Therapy and Research, 39, 292–306. Scholar
  29. Peckham, A., McHugh, K., & Otto, M. (2010). A meta-analysis of the magnitude of biased attention in depression. Depression and Anxiety, 27, 1135–1142. Scholar
  30. Piccinelli, M., & Wilkinson, G. (2000). Gender differences in depression. British Journal of Psychiatry, 177, 486–492. Scholar
  31. Sanchez, A., Romero, N., & De Raedt, R. (2017). Depression-related difficulties disengaging from negative faces are associated with sustained attention to negative feedback during social evaluation and predict stress recovery. PLoS ONE, 12, e0175040. Scholar
  32. Sears, C., Quigley, L., Fernandez, A., Newman, K., & Dobson, K. (2018). The reliability of attentional biases for emotional images measured using a free-viewing eye-tracking paradigm. Behavior Research Methods. Scholar
  33. Sears, C. R., Newman, K. R., Ference, J. D., & Thomas, C. L. (2011). Attention to emotional images in previously depressed individuals: An eye-tracking study. Cognitive Therapy and Research, 35, 517–528. Scholar
  34. Solomon, D. A., Keller, M. B., Leon, A. C., Mueller, T. I., Lavori, P. W., Shea, M. T., … Endicott, J. (2000). Multiple recurrences of major depressive disorder. American Journal of Psychiatry, 157, 229–233. Scholar
  35. Soltani, S., Newman, K., Quigley, L., Fernandez, A., Dobson, K., & Sears, C. (2015). Temporal changes in attention to sad and happy faces distinguish currently and remitted depressed individuals from never depressed individuals. Psychiatry Research, 230, 454–463. Scholar
  36. Spitzer, R., Kroenke, K., Williams, J., & The Patient Health Questionnaire Primary Care Study Group (1999). Validation and utility of a self-report version of the PRIME-MD: The PHQ primary care study. Journal of the American Medical Association, 282, 1737–1744. Scholar
  37. Tottenham, N., Tanaka, J., Leon, A., McCarry, T., Nurse, M., Hare, T., Marcus, D., Westerlund, A., Casey, B., & Nelson, C. (2009). The NimStim set of facial expressions: Judgments from untrained research participants. Psychiatry Research, 168, 242–249. Scholar
  38. Waechter, S., Nelson, A., Wright, C., Hyatt, A., & Oakman, J. (2014). Measuring attentional bias to threat: Reliability of dot probe and eye movement indices. Cognitive Therapy and Research, 38, 313–333. Scholar
  39. Woody, M., Owens, M., Burkhouse, K., & Gibb, B. (2016). Selective attention toward angry faces and risk for major depressive disorder in women: Converging evidence from retrospective and prospective analyses. Clinical Psychological Science, 4, 206–215. Scholar
  40. Yiend, J. (2010). The effects of emotion on attention: A review of attentional processing of emotional information. Cognition and Emotion, 24, 3–47. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of CalgaryCalgaryCanada
  2. 2.Ferkauf Graduate School of PsychologyYeshiva UniversityBronxUSA

Personalised recommendations